Special Edition: Michigan Medicaid Budget and More | June 2016
The Michigan Update
In This Issue
Medicaid
Managed Care
Enrollment
Activity
Healthy Michigan
Plan
Flint Medicaid
Wavier
MI Health Link
Medicaid Managed Care Enrollment Activity
The Michigan Department of Health and Human Services (MDHHS)
has advised that technical problems have delayed release of
managed care enrollment numbers for Medicaid, Healthy Michigan
Plan, dually eligible Medicare-Medicaid, Children's Special Health
Care Services, and MIChild enrollees. Enrollment numbers were
not received in May and have not yet been received for June.
When information is available, it will be reported in The Michigan
Update.
For additional information, contact Esther Reagan, Senior
Consultant, at (517) 482-9236.
Michigan D-SNPs
Healthy Michigan Plan
2016-2017
Michigan
Department of
Health and
Human Services
(MDHHS) Budget
The Healthy Michigan Plan (HMP) enrollment level, according to
the Michigan Department of Health and Human Services (MDHHS)
website, stood at 620,090 as of May 31, 2016 and at 595,593
as of June 6, 2016. As these two enrollment numbers show, the
HMP caseload drops by about 25,000 at the beginning of each
month as a result of an annual eligibility redetermination
requirement; it generally rebounds by the end of the month.
Health Insurance
Claims
Assessment
(HICA) and Use
Tax
For additional information, contact Esther Reagan, Senior
Consultant, at (517) 482-9236.
State Innovation
Model: PatientCentered Medical
Homes
On May 9, 2016, the Michigan Department of Health and Human
Services announced that children and pregnant women served by
the city of Flint's water system since April 2014 could begin
enrolling in Medicaid, MIChild, or the Healthy Michigan Plan. An
estimated 15,000 children and pregnant women in families with
Flint Medicaid Wavier
Medicaid Benefits
and Zika Virus
Child Lead
Poisoning
Elimination Board
Oral Health
Coalition Unveils
Plan to Improve
Dental Access
MDHHS Chief
Deputy Director
Medicaid Policies
Quick Links
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Expertise
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Washington, DC
incomes below 400 percent of the federal poverty level are eligible
through the special "Flint Water Group" category under the
provisions of the waiver recently approved by the federal
government. These individuals qualify for retroactive Medicaid
coverage for services received on or after March 1, 2016.
For additional information, contact Esther Reagan, Senior
Consultant, at (517) 482-9236.
MI Health Link
In previous editions of The Michigan Update we have written about
Michigan's implementation of an integrated health care delivery
system for adults dually eligible for Medicare and Medicaid (duals).
The demonstration, called MI Health Link, will last for five years
(through 2019) and operate in four regions of the state. The entire
Upper Peninsula is one region; eight counties in the southwest
corner of the state form another region (Barry, Berrien, Branch,
Calhoun, Cass, Kalamazoo, St. Joseph, and Van Buren); and
Wayne and Macomb Counties are two single-county regions.
As of May 1, 2016, the Michigan Department of Health and Human
Services (MDHHS) reports there were 30,813 enrollees in these
health plans, down from 31,766 in April, and down from 42,727 in
September 2015 when the demonstration was fully implemented.
Enrollment figures for June have not yet been received from
MDHHS.
About 16 percent of the enrollees voluntarily joined the MI Health
Link demonstration (this percentage has more than doubled in the
last six months). Most participants were passively enrolled
(assigned to a health plan but with the ability to change to a
different plan or opt out of the demonstration). Also as of May 1st,
more than 48,000 duals eligible for participation in the
demonstration have chosen to opt out (not participate). These
individuals will receive their Medicaid benefits on a fee-for-service
basis but retain the option to voluntarily enroll in the
demonstration at a later time.
There are seven ICOs serving one or more of the demonstration
regions. The table below provides enrollment information by
region for each ICO.
MI Health
Link
Enrollment
May 1,
2016
Aetna Better
Health
Upper
Pen.
Region
SW MI
Region
Macomb
Region
Wayne
Region
2,810
516
1,958
Total
5,284
AmeriHealth
Michigan
MI Complete
Health /
Fidelis
HAP Midwest
Health Plan
Meridian
Health Plan
of MI
Molina
Healthcare
of MI
Upper
Peninsula
Health Plan
Total
569
2,021
2,590
381
1,888
2,269
853
3,651
4,504
4,475
4,475
1,295
6,889
3,507
3,507
8,184
3,507
7,285
3,614
16,407
30,813
Molina Healthcare of Michigan has the most enrollees, both
voluntarily and passively enrolled (26.6 percent of the combined
total); Aetna Better Health of Michigan has 17.1 percent of the
total; HAP Midwest Health Plan has 14.6 percent; and Meridian
Health Plan of Michigan has 14.5 percent. At this point, more than
94 percent of the MI Health Link enrollees are living at home, but
less than one percent of them are receiving home and communitybased long-term services and supports (although many are
receiving personal care in the home). About 5.6 percent of the MI
Health Link enrollees live in a nursing facility. Although all of the
plans have enrollees receiving care in nursing facilities, Molina
Healthcare of Michigan has the largest share, more than 26
percent of the total.
As noted above, the MI Health Link enrollment total has dropped a
little each month since September 2015 when there were 42,727
enrollees in the demonstration. Part of this decrease in enrollment
may be attributable to temporary disruptions in Medicaid
eligibility. In many instances when Medicaid eligibility is
reinstated, the department is not permitted to passively enroll the
dual a second time; if the dual wants to participate in MI Health
Link, they need to voluntarily re-enroll in the demonstration.
MDHHS has recently announced that, within allowable parameters,
it will begin passively enrolling certain duals into the ICOs on a
monthly basis, including duals newly eligible for MI Health Link
enrollment since the last passive assignment process in 2015,
duals who recently moved into one of the demonstration areas,
certain duals eligible for passive enrollment but who temporarily
lost their Medicaid eligibility in 2015, and qualified individuals
newly eligible for Medicare for whom the Centers for Medicare &
Medicaid Services has not already assigned a plan. The first
passive enrollment group is expected to include about 15,000
individuals: at least 900 in the Upper Peninsula region, more than
2,750 in each of the Southwest and Macomb County regions, and
more than 9,000 in the Wayne County region. These passive
enrollments were scheduled to be effective June 1, 2016. The
results of this enrollment process will be reported when
information is available from MDHHS.
The MDHHS has established an enrollment dashboard on the MI
Health Link page on its website. According to the MI Health Link
website, for May 2016, more than half of the MI Health Link
enrollees are individuals under the age of 65. These younger
individuals qualified for Medicare and Medicaid based on a
disability.
For additional information, contact Esther Reagan, Senior
Consultant, at (517) 482-9236.
Michigan D-SNPs
Four of the 11 Medicaid HMOs in Michigan (or their parent
organizations) are also federally contracted as D-SNPs (Medicare
Advantage Special Needs Plans for persons dually eligible for
Medicare and Medicaid [duals]) to provide Medicare benefits for
duals in Michigan: HAP Midwest Health Plan, Meridian Health Plan
of Michigan, Molina Healthcare of Michigan, and Upper Peninsula
Health Plan. As of May 1, 2016 these four D-SNPs had a combined
enrollment of 12,990 duals for whom they provide Medicare
services. Almost 80 percent of the duals enrolled in a D-SNP are
enrolled in the Molina plan. None of these duals are participating
in the MI Health Link demonstration.
Not all of the duals enrolled in these D-SNPs are eligible to receive
full Medicaid benefits. Some only receive assistance from the
Medicaid program with their Medicare coinsurance and deductible
payments and/or monthly Medicare premiums.
For more information, contact Esther Reagan, Senior Consultant,
at (517) 482-9236.
2016-2017 Michigan Department of Health and
Human Services (MDHHS) Budget
Michigan's Revenue Estimating Conference, held on May 17, 2016,
resulted in a reduction of $460 million in estimated revenues for
the 2016-2017 fiscal year (FY), which will begin October 1, 2016.
Based on the revised revenue estimates, new targets were
established for the budgets for state agencies and programs. The
state general fund target for MDHHS was reduced by $33 million
from Governor Rick Snyder's original Executive Budget
Recommendation.
All other conference committees completed their work by June 1st
and reported their recommendations to the full legislature. The
conference committee on the MDHHS budget was scheduled to
meet on June 1st, but was recessed due to inability to reach
consensus on language related to quality reporting requirements
for hospitals receiving Medicaid Graduate Medical Education (GME)
payments. The committee met briefly on June 7th and adopted an
agreement on the MDHHS budget. Highlights of the Medicaid and
mental health provisions of the budget are noted below.
Funding for Specialty Drugs
With respect to specialty medications, Michigan's Pharmacy and
Therapeutics Committee recently recommended coverage of
additional drugs to treat Cystic Fibrosis and Hepatitis C. These
drugs were added to the Medicaid formulary in April 2016. The
conference committee budget for FY 2016-2017 includes $238. 2
million to cover the full year costs of Hepatitis C drugs for
Medicaid beneficiaries ($66.5 million in state general funds).
Coverage of Orkambi for Cystic Fibrosis for approximately 320
children enrolled in Medicaid and/or Children's Special Health Care
Services is budgeted at $66.3 million Gross ($43.7 million in state
general funds). The Executive budget had projected that 7,000
Medicaid beneficiaries would receive Hepatitis C treatments. The
conference committee estimates slightly more than 5,000
individuals will receive this service.
The Executive Budget proposal to create a pharmacy reserve fund
was not adopted.
Integration of Mental Health Services with Physical Health
Services
As noted in previous editions of The Michigan Update, the
Governor's budget for FY 2016-2017 included provisions related to
the integration of behavioral health services and physical health
services within the Medicaid program. Section 298 of the MDHHS
portion of the Executive Budget Bill went beyond initiating a study
of integration and proposed that by September 30, 2017 the
funding for Medicaid behavioral health services would be
transferred from the Prepaid Inpatient Health Plans (PIHPs) to the
Health Plan Services (HMO) budget.
This became the most contentious issue in the FY 2016-2017
budget. Both the House of Representatives and the Senate
replaced the Governor's recommendation with language that
created a workgroup and a report requirement related to
integrated behavioral and physical health services. The conference
committee language was based on the House language with
additional goals for the workgroup to consider. As summarized in
the conference committee decision document, the new Section
298 includes the following provisions:
1. Requires MDHHS to work with a workgroup to recommend
the most effective financing model and policies for
behavioral and physical health coordination. Language
includes required workgroup participants.
2. Workgroup goals must include: (a) core principles of
person-centered planning, (b) avoiding the return to a
medical and institutional model, (c) coordination of physical
and behavioral health services at the point of service, (d)
ensure full access to community-based services and
supports, (e) ensure full access to integrated behavioral
and physical health services, (f) reinvest efficiencies gained
back into services, and (g) ensure transparency.
3. Workgroup recommendations must include a plan for
transition to any new financing model or recommended
policies, including a plan to ensure continuity of care, and
consideration of one or more pilot programs.
4. Requires the workgroup to recommend annual benchmarks
to measure progress in implementation of any new
financing model or policy recommendations over a three
year period.
5. Requires a status update after each workgroup meeting
and a final report by January 15, 2017.
6. Prohibits the transfer of responsibility for behavioral health
services from the PIHPs to any other entity without
legislative authorization, except for pilot programs as
described in (3).
Hospital Quality Data Reporting
As noted above, the final issue that delayed agreement on the
conference report was language on quality reporting by hospitals.
The final version of Section 1805 requires that hospitals receiving
Medicaid GME payments must submit quality data to a non-profit
organization that meets certain standards. Consumers must be
able to "compare safe practices by hospital campus, including, but
not limited to, perinatal care, hospital-acquired infection, and
serious reportable events".
The Conference Report on the MDHHS budget included the
following policy and/or funding changes relative to current
year policy:
Healthy Kids Dental: The legislature agreed with the Executive
Recommendation to expand the Healthy Kids Dental program to
cover all eligible children in all Michigan counties at a cost of $25.6
million (state share of $8.9 million). The final expansion group is
children between the ages of 13 and 20 in Kent, Oakland and
Wayne Counties.
Adult Dental Services: The Senate had proposed increased rates
for adult dental services effective July 1, 2017 to rates that would
allow for a managed care contract for adult dental services. The
cost of the Senate proposal was $23.0 million. The conference
committee only included funding to increase reimbursement and
expand access to dental services for pregnant women enrolled in
Medicaid, at a cost of $2,726,000 ($950,000 state general fund).
Medicaid Health Plan Efficiencies: The conference committee
reduced funding for Medicaid HMOs by $37.9 million ($10.2 million
state general fund) based on assumed efficiencies related to
Emergency Department utilization, reductions in hospital
readmissions, and other utilization efficiencies.
Private Duty Nursing: The Senate proposed to increase rates by
20 percent at a cost of $6.6 million. The House provided $3.3
million for a 10 percent rate increase. The conference committee
settled on a rate increase of 15 percent at a cost of $4.95 million
(state share of $1.725 million). Private duty nursing
reimbursement rates were last increased more than a decade ago.
Ambulance Rates: The budget for FY 2016-2017 expands the
Quality Assurance Assessment Program (QAAP) for ambulance
providers to provide rate increases in managed care and Healthy
Michigan Plan payments for ambulance services. Funding for this
rate increase is $35.5 million. With federal funds and QAAP
assessments paid by ambulance providers, there is a net state
general fund savings of $2.9 million.
PACE: The FY 2016-2017 budget expands funding for the Program
of All-inclusive Care for the Elderly (PACE) from $66 million to
$92.5 million. This proposed expansion allows for additional slots
at current Michigan PACE sites and new sites in Jackson and
Traverse City. There is no net budgetary impact as funding for
other long-term care services was reduced by the same amount.
Community Mental Health Non-Medicaid funding: The funding for
non-Medicaid services from Community Mental Health was
increased by $3.0 million.
Primary Care: The Senate increased rates for primary care
services by 6 percent. This increase was not included in the
conference recommendation. The conference report includes
language (Section 1701) directing MDHHS to consider
implementing a Direct Primary Care Pilot for Medicaid
beneficiaries. The direct primary care provider must be under
contract with at least one Medicaid Health Plan. If a pilot program
is initiated, the legislature has specified a minimum set of
performance measures, including an assessment of the direct
primary care costs and the savings generated from direct primary
care. The budget does not include any new funding for this
potential initiative.
Dental Clinics: The conference committee doubled the funding for
the University of Detroit Dental Clinic from the current $1 million
to a total of $2 million for FY 2016-2017. The funding is 100
percent from the state general fund. The conference committee
also included $1.55 million of general fund money for possible
support of rural dental clinics.
State Innovation Model (SIM): The Senate reduced SIM funding
from $25 million to $100 to create an opportunity to discuss the
Blueprint for Health Innovation in the conference committee. The
conference committee agreed to reduce the funding by $15
million, leaving $10 million for FY 2016-2017. (These are 100
percent federal funds.)
Other Medicaid and Medical Services Administration
Changes
The total budget for physical health care for Medicaid beneficiaries
is $14.46 billion, of which the state general fund share is $2.07
billion. The FY 2016-2017 budget includes a few notable changes
for the Medical Services Administration. In addition, there are
many technical adjustments in the Medicaid budget.
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Integrated Service Delivery: The FY 2016-2017 budget
includes 15 new positions and $43.2 million to update and
streamline the electronic application and enrollment
process for services through MDHHS. (The non-federal
share is 10 percent, or $4.32 million.)
Healthy Michigan Plan (HMP) Administration: The FY 20162017 budget reduces funding for the HMP call center by
$8.1 million and also reduces funding for HMP marketing
and advertising by $1 million.
Fewer individuals dually enrolled in Medicaid and Medicare
are choosing the Integrated Care Organizations (ICO) as
part of the "duals demonstration" than was anticipated by
the FY 2015-2016 budget. As a result, $239.8 million is
removed from the ICO budget line and the long-term care
services line is similarly increased.
The federal requirement to eliminate the Use Tax on
Medicaid HMOs and the PIHPs as of January 1, 2017 has a
negative revenue implication for the state which is not
specific to the Medicaid budget. Since the cost of this tax is
an allowable cost for the Medicaid Health Plans and the
PIHPs and therefore reimbursed by Medicaid, elimination of
the tax reduces Medicaid and Healthy Michigan Plan HMO
and PIHP costs by about $479.5 million (state general fund
share of $165.0 million) for the nine months from January
to September of 2017.
Actuarially Sound Rates: The budget includes funding for a
2 percent rate increase for HMOs for the Healthy Michigan
Plan and a 1.5 percent rate increase for the PIHPs and
HMOs for traditional Medicaid.
Both a summary Conference Report and a detailed Conference
Report are available online from the Senate Fiscal Agency. The
actual bill is also available on the legislature's website.
For more information, contact Eileen Ellis, Senior Fellow, at (517)
482-9236.
Health Insurance Claims Assessment (HICA) and
Use Tax
On May 24, 2016, a set of four bills was introduced in the Michigan
Senate to continue the Use Tax on Medicaid Health Plans (HMOs)
and Prepaid Inpatient Health Plans (PIHPs) under a revised
structure as of January 1, 2017 and would eliminate the HICA tax
as of that same date (which is otherwise scheduled to increase
from 0.75 percent to 1.0 percent on January 1, 2017).
The four bills would do the following:
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Create a new version of the Medicaid managed care Use
Tax as of January 1, 2017 (SB 989)
Designate that the funds collected by that tax be deposited
in a new "Health Services Fund" and be used for five
specified non-Medicaid purposes (SB 988)
Allocate State Income Tax revenues to fund the nonfederal share of the cost of reimbursing Medicaid HMOs and
PIHPs for their incurred taxes (SB 990)
Modify the HICA to end on December 31, 2018, and to be
reduced to 0.0 percent on January 1, 2017 if the federal
government agrees to match the cost to the Medicaid
managed care entities of the new Use Tax.
The five programs that would be supported by the Health Services
Fund are:
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Safe Drinking Waiver Revolving Fund ($2.0 million)
Community Mental Health non-Medicaid services ($100
million)
Local public health department non-Medicaid services
($30.0 million)
Federal Medicare Pharmaceutical Program ($150 million in
FY 2016-2017 and $204 million in each subsequent fiscal
year)
Clinical and mental health services in the Department of
Corrections (balance of funds collected).
The bills were sent to the Senate Committee on Michigan
Competitiveness which reported them out to the full Senate with a
favorable recommendation and without amendment. The full
Senate approved the bills on June 8th. The House has received the
bills and referred them to the House Committee on Insurance.
For more information, contact Eileen Ellis, Senior Fellow, at (517)
482-9236.
State Innovation Model: Patient-Centered Medical
Homes
The Michigan Department of Health and Human Services (MDHSS)
recently announced the first phase of Accountable Systems of
Care within the Blueprint for Health Innovation initiative,
Michigan's State Innovation Model (SIM). The first phase of this
multi-payer initiative will focus on Patient-Centered Medical Homes
(PCMH). The PCMH initiative is scheduled to begin on January 1,
2017, to coincide with the December 31, 2016 end of the Michigan
Primary Care Transformation (MiPCT) initiative. Physician practices
interested in the SIM PCMH initiative must submit an "Intent to
Participate" (ITP) by June 30, 2016.
Michigan was one of eight states that received funding in 2012 for
the Multi-Payer Advanced Primary Care Practice Demonstration.
MiPCT, which brought together Medicare, Medicaid, and several
private insurers, reached over 1.2 million patients served by 1,900
providers in 350 primary care practices. Participating practices
received funding for practice transformation, care coordination,
and performance incentives.
The SIM PCMH initiative is open to any current MiPCT practice in
any region of the state, and to other physician practices located in
the 2017 SIM pilot regions. These five regions are:
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Genesee County
Jackson County
Muskegon County
Washtenaw and Livingston Counties
Northern Michigan (Antrim, Benzie, Charlevoix, Emmet,
Grand Traverse, Kalkaska, Manistee, Missaukee, and
Wexford Counties)
It should be noted that the Northern Michigan Community Health
Innovation Region includes additional counties, but only these nine
counties are included in the 2017 SIM PCMH initiative.
Information about the intent to participate process is available on
the MDHSS website. As noted above, the ITP must be completed
by June 30, 2016. The ITP is non-binding. Practices that complete
the ITP will subsequently receive a full application and
participation agreement. According to a MDHHS webinar held May
11, 2016, physician practices must be able to demonstrate that by
January 1, 2017 they will have certain capabilities including:
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Accreditation as a PCMH from one of several recognized
bodies
Implementation of an Electronic Health Record
Enrollment as a Medicaid provider
Embedded care management / coordination staff meeting
standards set by the Initiative
The PowerPoint slides from the May 11th webinar are also
available at the website link noted above.
For more information, contact Eileen Ellis, Senior Fellow, at (517)
482-9236.
Medicaid Benefits and Zika Virus
On June 1, 2016, the federal Department of Health and Human
Services released an Informational Bulletin to inform State
Medicaid agencies and other interested stakeholders about how
Medicaid services and authorities can help states and territories
prevent, detect, and respond to the Zika virus. The letter
identified and encouraged states to use federal funding flexibilities
available.
For more information, contact Eileen Ellis, Senior Fellow, at (517)
482-9236.
Child Lead Poisoning Elimination Board
Governor Rick Snyder issued Executive Order 2016-9 on May 20,
2016 has created a new Child Lead Poisoning Elimination Board
that will be chaired by Lieutenant Governor Brian Calley and
include 11 additional members. The board is created as a
temporary commission and is charged with making
"recommendations to the Governor concerning testing of children
for elevated blood lead, follow-up monitoring and services,
including case management; environmental lead investigations;
remediation and abatement; and dashboards and reporting." A
written report is due to the Governor by November 4, 2016.
Directors, or their designees, from the departments of
Environmental Quality, Health and Human Services, Licensing and
Regulatory Affairs and the Michigan State Housing Development
Authority will be part of the board, along with seven additional
appointees: Riley Alley, Dr. Mona Hanna-Attisha, Mayor Rosalyn
Bliss, Paul Haan, Rebecca Meuninck, Dr. Abdul El-Sayed, and Lyke
Thompson.
For more information, contact Esther Reagan, Senior Consultant,
at (517) 482-9236.
Oral Health Coalition Unveils Plan to Improve
Dental Access
On May 17, 2016, the Oral Health Coalition in collaboration with
the Michigan Department of Health and Human Services released
the 2020 Michigan State Oral Health Plan and a companion
Progress Report. The Plan is focused on improving three key goals
around dental health: enhancing professional integration between
providers across the lifespan; increasing knowledge and
awareness of the importance of oral health to overall health; and
increasing access to oral health care among underserved and/or
hard to reach populations.
For more information, contact Esther Reagan, Senior Consultant,
at (517) 482-9236.
MDHHS Chief Deputy Director
On May 31, 2016, Michigan Department of Health and Human
Services Director Nick Lyon announced that his Chief Deputy
Director, Tim Becker, will be leaving the department on July 8,
2016 to join Hope Network as executive vice president. His
successor has not yet been named.
For more information, contact Esther Reagan, Senior Consultant,
at (517) 482-9236.
Medicaid Policies
Since our last newsletter, the Michigan Department of Health and
Human Services (MDHHS) has issued ten final policies and five
proposed policies, two of which were issued simultaneously with
final policies, that merit mention. They are available for review on
the department's website.
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MSA 16-10 notifies All Providers that Targeted Case
Management Services are covered for pregnant women
and children served by the Flint water system. This
policy was simultaneously released for public comment
(1612-TCM-Flint), with comments due to MDHHS by June
8, 2016. The policy notes that it is contingent upon
legislative funding appropriation (which has occurred) and
State Plan approval from the federal government.
MSA 16-11 notifies All Providers and Bridges Eligibility
Manual Holders of a new Medicaid eligibility category
- Flint Water Group (FWG) - for pregnant women and
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children served by the Flint water system. This policy was
simultaneously released for public comment (1614-FWG),
with comments due to MDHHS by June 8, 2016.
MSA 16-12 advises Local Health Departments,
Hospitals, Physicians, Clinics and Pharmacies that the
Children's Special Health Care Services (CSHCS) program
may cover the out-of-pocket pharmacy costs related to
covered diagnoses for beneficiaries enrolled with a
Medicare Part D Pharmacy Drug Plan.
MSA 16-13 notifies Federally Qualified Health Centers,
Hospitals, Local Health Departments, Medicaid Health
Plans and Others that MDHHS is implementing MI Care
Team (a Primary Care Health Home Benefit) effective July
1, 2016.
MSA 16-14 advises Practitioners, Hospitals, Clinics,
Prepaid Inpatient Health Plans, Medicaid Health
Plans and Others that fully-licensed Marriage and Family
Therapists may enroll as Medicaid providers and bill for
services directly. They will no longer be required to file
claims under a delegating/supervising physician's identifier.
MSA 16-15 informs Medicaid Health Plans,
Practitioners and Others of a new form for prior
authorization of Practitioner services. A facsimile of
the form is attached.
MSA 16-16 clarifies for Ambulance Providers, Hospitals
and Medicaid Health Plans Medicaid policy pertaining to
prior authorization of ambulance services.
MSA 16-17 advises Bridges Eligibility Manual Holders
of an update to resource eligibility policy for
Supplemental Security Income related Medicaid programs.
MSA 16-18 notifies Medicaid Private Duty Nursing
Providers of updates to the Private Duty Nursing
Chapter of the Medicaid Provider Manual.
MSA 16-20 notifies All Providers of Quarterly Updates
to the Medicaid Provider Manual.
A proposed policy (1616-EPSDT) has been issued that
would clarify program policy regarding coverage of
behavioral health treatment services for children
with Autism Spectrum Disorders. Comments are due to
MDHHS by June 16, 2016.
A proposed policy (1606-LHD) has been issued that would
revise Medicaid outreach requirements for Local
Health Departments and clarify federal Medicaid
matching fund claiming requirements. Comments are due
to MDHHS by June 17, 2016.
A proposed policy (1617-LHD) has been issued that would
align Medicaid policy with an approved State Plan
Amendment allowing on-site environmental
investigations related to blood lead poisoning of a
beneficiary's home or primary residence. Comments are
due to MDHHS by July 15, 2016.
MDHHS has also released ten L-letters of potential interest, which
are available for review on the same website.
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L 16-22 was released on May 2, 2016 to remind Nursing
Facilities about Medicaid financial eligibility policy related
to the purchase of private insurance policies for
coverage of ancillary services and of the program's
policies related to offsetting patient pay amounts.
L 16-28 was released on May 2, 2016 as a notice of the
department's intent to submit a waiver amendment for
the Section 1915(b) MI Choice waiver. The purpose of
the amendment is to add non-emergency medical
transportation as a covered service under the waiver
and to implement the coverage in a geographically
phased manner. The first phase counties are identified in
the letter. L 16-32 was released on May 31, 2016 as
additional information. L 16-33 was also released on
May 31, 2016 to Interested Parties, including MI
Choice Waiver Agencies with information about the
waiver amendment.
L 16-21 was released on May 9, 2016 to MI Choice
Waiver Directors to clarify current expectations regarding
the Nursing Facility Level of Care Determination
process.
L 16-30 was released on May 17, 2016 as a notice of the
department's intent to submit a State Plan Amendment to
update Plan language referencing the fee schedules and
effective dates listed under Individual Practitioner
Services.
L 16-24 was released on May 17, 2016 to clarify how
days should be counted for correct billing of Hospice
services.
L 16-31 was released on May 18, 2016 to School Based
Services providers to provide amended contract bill back
information for the State Fiscal Year 2016.
L 16-08 was released on May 19, 2016 as a notice of the
department's intent to submit a State Plan Amendment
related to Diabetes Self-Management Education and
Training programs.
L 16-19 was released on May 26, 2016 to notify Medicaid
providers that received at least $5 million in
payments during calendar year 2015 of reporting
requirements associated with the Deficit Reduction Act of
2005.
For additional information, contact Esther Reagan, Senior
Consultant, at (517) 482-9236.
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Michigan, Health Management Associates provides leadership,
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